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Objective: To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA. Methods: A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes. Results: For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube. Conclusion: Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway. [ABSTRACT FROM AUTHOR]

Objective: Many non‐airway‐trained personnel are uncomfortable managing altered airway anatomy (AAA), including tracheostomy and total laryngectomy (TL) patients. Significant morbidity and mortality have resulted from first responders' inability to stabilize the airway until expert airway providers arrive. All medical school graduates should demonstrate competency of this life‐saving skill. Our hypothesis was hands‐on interactive simulation using 3‐dimensional (3D)‐printed models would improve AAA knowledge and confidence. Study Design: Blinded, prospective cohort study. Setting: The Ohio State University College of Medicine. Methods: A novel curriculum was designed to teach all third‐year medical students AAA fundamentals via case‐based discussions, surgical videos, and hands‐on student demonstration of competency by inserting a tracheostomy and endotracheal tube through 3D‐printed tracheostoma models. Pre‐ and postcourse 5‐item Likert scale surveys and AAA knowledge assessments were administered. Results: Students (n = 258) felt more comfortable with knowledge of AAA equipment (3.99 vs 1.38, P <.0001), ability to stabilize AAA patients until expert airway providers arrive (3.67 vs 1.37, P <.0001), and AAA overall (3.75 vs 1.49, P <.0001) postcourse vs precourse. AAA knowledge assessment scores improved from 34.3% precourse to 75.6% postcourse (P <.0001). Interestingly, 30.7% chose bag‐mask ventilation over mouth and nose and/or transoral/transnasal intubation for a total laryngectomy patient precourse vs 5.5% postcourse (P <.0001). In total, 86.7% reported inadequate exposure to AAA in medical school and 98.4% found the course to be a valuable experience. Conclusion: This hands‐on course significantly increases medical student knowledge and comfort managing AAA patients. The course can be expanded to various trainees and providers to further promote AAA education and ultimately improve patient safety. [ABSTRACT FROM AUTHOR]

Background: Initial management and stabilization of epistaxis is managed by a diverse offset of clinical providers with variable levels of training. Objective: To determine the anatomic and clinical fidelity and ease of use of a novel simulator for the training and assessment of epistaxis management skills. Study Design: Qualitative Research Study using expert questionnaire's for validation of a newly developed simulator. Methods: We performed a quasi‐experimental intervention with 22 otolaryngology faculty and 10 trainees who independently evaluated the simulator. Data were collected in three phases: phase 1 (preliminary evaluation), phase 2 (final expert evaluation), and phase 3 (trainee evaluation). We designed a three‐dimensional (3D) printed model from a de‐identified patient computed tomography scan. Artificial blood was circulated through catheters to simulate bleeding from three distinct sites (sphenopalatine, Kiesselbach's plexus, and anterior ethmoid). Four domains were assessed: "Physical and anatomic attributes," "Realism of experience," "Ability to perform tasks," and "Value and clinical relevance." Internal structure and validity were measured with Cronbach's alpha and item outfit mean‐square statistics. Results: Results from otolaryngology faculty showed very high median ratings for "Value of the simulator as a training tool" (4.0/4) and high ratings for "Relevance to practice" (4.0/4), and realism of experience (4.0/4). Responses from otolaryngology trainees demonstrated high value for clinical training (4.0/4) and high likelihood to recommend use for future trainees (4.0/4). Confidence in managing epistaxis before (1.0/4) and after (3.0/4) simulator use was statistically improved (P =.03). Conclusions: Using 3D printing technology, we created a novel simulator for epistaxis management. Preliminary evidence suggests the model is cost‐effective, anatomically realistic, relevant to trainees' educational needs, and valuable as a training tool. Level of Evidence: 3 Laryngoscope, 132:747–753, 2022 [ABSTRACT FROM AUTHOR]

Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction. [ABSTRACT FROM AUTHOR]